Pulmonary Embolism: Surgical Therapy

In principle, the following measures are available for the acute therapy of pulmonary embolism:

  • Anticoagulation (anticoagulation; NOAK: apixaban, dabigatran, edoxaban, and rivaroxaban) or intravenous thrombolysis (dissolving the thrombus) as an emergency measure in case of hemodynamic deterioration (ESC guideline: class 1 recommendation).
  • Recanalizing procedures (reopening of displaced vessels): thrombectomy (surgical removal of a blood clot (thrombus) from a blood vessel) (ESC guideline: class 2a recommendation).

In any case, secondary prophylaxis with vitamin K antagonists such as phenprocoumon is required.

Depending on the severity of pulmonary embolism, the following therapeutic regimens can be distinguished:

  1. Anticoagulation alone (anticoagulation).
  2. Systemic thrombolysis or anticoagulation alone.
  3. Systemic thrombolysis, recanalizing procedures or surgery if necessary.
  4. Systemic thrombolysis, if necessary recanalizing procedures or surgery (time!!).

In severity 3 or 4, the following recanalizing procedures are used:

  • Catheter-based thrombus fragmentation – comminution of the thrombus using catheter procedures.
  • Embolectomy/plumonalisthrombectomy – surgical removal of the embolus from the opened vessel.
  • Pulmonary endarterectomy – removal of the embolus in patients who develop chronic thromboembolic pulmonary hypertension (“pulmonary hypertension”).